Can intranasal corticosteroids cause migraine-like headache?

Area of Science:

• Pharmacovigilance
• Neurology
• Allergy and Immunology

Background:

• Intranasal corticosteroids (INCs) are widely used for rhinitis, with a presumed minimal systemic effect.
• Rhinitis is a known condition associated with migraine.
• Concerns exist regarding potential systemic effects of INCs despite their local action.

Purpose of the Study:

• To investigate an unexpected cluster of migraine case reports associated with intranasal corticosteroid (INC) use.
• To analyze data from the World Health Organization's global pharmacovigilance program regarding INC-associated adverse events.
• To assess the potential link between INCs and the occurrence or exacerbation of migraine.

Main Methods:

• Review of international pharmacovigilance data from the World Health Organization.
• Identification and analysis of case reports linking intranasal corticosteroids to migraine.
• Examination of drug re-challenge data in reported cases.

Main Results:

• A cluster of 38 case reports of migraine was identified in suspected connection with INC use.
• The INC was the sole suspect drug in all reported cases.
• Eight out of nine patients experienced recurrent migraine upon re-exposure to the INC, suggesting a potential causal link.

Conclusions:

• International pharmacovigilance data suggest a possible association between intranasal corticosteroid use and the causation or triggering of migraine or migraine-like headaches.
• Despite the known association between rhinitis and migraine, the observed cluster and re-challenge data warrant further investigation.
• Additional research is necessary to confirm the association and elucidate the underlying mechanisms of INC-induced migraines.